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Is there a role for MRI in the preoperative assessment of patients with DCIS?
Ann Surg Oncol. 2010 Sep; 17(9):2395-400.AS

Abstract

BACKGROUND

Breast magnetic resonance imaging (MRI) is used to identify residual and additional disease in patients with invasive carcinoma. The use of MRI in assessing extent of disease for ductal carcinoma in situ (DCIS) is less well defined. This study assessed the value of MRI in the preoperative evaluation of DCIS.

MATERIALS AND METHODS

We identified 98 patients with DCIS in 2007. Of these, 63 underwent stereotactic biopsy, followed by MRI. There were 35 who underwent stereotactic biopsy alone. Concordance between MRI and histopathology was defined as the presence or absence of residual disease.

RESULTS

There was no significant difference in mastectomy rates between the MRI and non-MRI group (20.3% vs 25.7%, P = .62). In patients undergoing breast-conserving surgery (BCS), there were fewer positive margins in the MRI versus the non-MRI group (21.2% vs 30.8%, P = .41). Of the 64 cases that underwent preoperative MRI, 43 (67.2%) were concordant. Also, 15 of 43 cases (34.8%) had MRI results that accurately predicted pathologic size. In 28 of 43 patients (65.2%), MRI overestimated disease in 20, by a mean of 1.97 cm. In patients with MRI tumor size >2 cm, MRI overestimated disease by a mean of 3.17 cm. Of the 64 cases, 21 (32.8%) were discordant. Also, 10 of 21 (47.6%) had a positive MRI and no residual disease on histopathology, and 11 of 21 (52.3%) had negative MRI and residual disease on pathology.

CONCLUSIONS

MRI does not accurately predict extent of disease in patients with extensive DCIS. In patients with MRI tumor size < or = 2 cm, MRI may assist in surgical planning. MRI results in patients with DCIS should be interpreted with caution; decision for mastectomy should not be made on MRI findings alone.

Authors+Show Affiliations

Department of Surgery, Drexel University College of Medicine, Philadelphia, PA, USA. lisa.weisfelner@drexelmed.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20217259

Citation

Allen, Lisa R., et al. "Is There a Role for MRI in the Preoperative Assessment of Patients With DCIS?" Annals of Surgical Oncology, vol. 17, no. 9, 2010, pp. 2395-400.
Allen LR, Lago-Toro CE, Hughes JH, et al. Is there a role for MRI in the preoperative assessment of patients with DCIS? Ann Surg Oncol. 2010;17(9):2395-400.
Allen, L. R., Lago-Toro, C. E., Hughes, J. H., Careaga, E., Brown, A. T., Chernick, M., Barrio, A. V., & Frazier, T. G. (2010). Is there a role for MRI in the preoperative assessment of patients with DCIS? Annals of Surgical Oncology, 17(9), 2395-400. https://doi.org/10.1245/s10434-010-1000-9
Allen LR, et al. Is There a Role for MRI in the Preoperative Assessment of Patients With DCIS. Ann Surg Oncol. 2010;17(9):2395-400. PubMed PMID: 20217259.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Is there a role for MRI in the preoperative assessment of patients with DCIS? AU - Allen,Lisa R, AU - Lago-Toro,Claudia E, AU - Hughes,Jenevieve H, AU - Careaga,Eduardo, AU - Brown,Anjeanette T, AU - Chernick,Michael, AU - Barrio,Andrea V, AU - Frazier,Thomas G, Y1 - 2010/03/09/ PY - 2009/03/16/received PY - 2010/3/11/entrez PY - 2010/3/11/pubmed PY - 2010/12/16/medline SP - 2395 EP - 400 JF - Annals of surgical oncology JO - Ann Surg Oncol VL - 17 IS - 9 N2 - BACKGROUND: Breast magnetic resonance imaging (MRI) is used to identify residual and additional disease in patients with invasive carcinoma. The use of MRI in assessing extent of disease for ductal carcinoma in situ (DCIS) is less well defined. This study assessed the value of MRI in the preoperative evaluation of DCIS. MATERIALS AND METHODS: We identified 98 patients with DCIS in 2007. Of these, 63 underwent stereotactic biopsy, followed by MRI. There were 35 who underwent stereotactic biopsy alone. Concordance between MRI and histopathology was defined as the presence or absence of residual disease. RESULTS: There was no significant difference in mastectomy rates between the MRI and non-MRI group (20.3% vs 25.7%, P = .62). In patients undergoing breast-conserving surgery (BCS), there were fewer positive margins in the MRI versus the non-MRI group (21.2% vs 30.8%, P = .41). Of the 64 cases that underwent preoperative MRI, 43 (67.2%) were concordant. Also, 15 of 43 cases (34.8%) had MRI results that accurately predicted pathologic size. In 28 of 43 patients (65.2%), MRI overestimated disease in 20, by a mean of 1.97 cm. In patients with MRI tumor size >2 cm, MRI overestimated disease by a mean of 3.17 cm. Of the 64 cases, 21 (32.8%) were discordant. Also, 10 of 21 (47.6%) had a positive MRI and no residual disease on histopathology, and 11 of 21 (52.3%) had negative MRI and residual disease on pathology. CONCLUSIONS: MRI does not accurately predict extent of disease in patients with extensive DCIS. In patients with MRI tumor size < or = 2 cm, MRI may assist in surgical planning. MRI results in patients with DCIS should be interpreted with caution; decision for mastectomy should not be made on MRI findings alone. SN - 1534-4681 UR - https://www.unboundmedicine.com/medline/citation/20217259/Is_there_a_role_for_MRI_in_the_preoperative_assessment_of_patients_with_DCIS L2 - https://dx.doi.org/10.1245/s10434-010-1000-9 DB - PRIME DP - Unbound Medicine ER -